Individual provider Active NPI

Nicole Marie Kappas, FNP

  • Nurse Practitioner
  • Lexington, SC
National Provider Identifier
1629882543
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
30724 Issued in SC
Practice address
1847 S Lake Dr
Lexington, SC 29073-7759
Phone
(803) 356-8998
Fax
(803) 356-8999
NPI assigned
Feb 3, 2025
Last updated
Sep 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 30724 SC Primary
Family Nurse Practitioner 363LF0000X 12753805-4405 UT

Addresses

Primary practice location

1847 S Lake Dr
Lexington, SC 29073-7759

Mailing address

PO Box 749306
Atlanta, GA 30374-9306

Other practice location 1

972 N 600 E
Spanish Fork, UT 84660-1306
Phone (801) 465-4896

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250213002445 UT Practitioner - Nurse Practitioner 3779013180 Reassigns benefits to 1 organization
I20251113000137 SC Practitioner - Nurse Practitioner 3779013180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Urgent Cares LLCGroup PAC ID 8628502598, 183 clinicians

Practice addresses (Care Compare)

6167 Braided Mane Pass SW
Aiken, SC 29803-7839
Phone (803) 648-1464

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
30724SCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Jan 13, 2025 Accepting new patients
Novant Health Urgent Cares LLC CurrentSince Sep 15, 2025 Accepting new patients
Revere Health PC CurrentSince Jan 13, 2025 Accepting new patients

Locations

6167 Braided Mane Pass SW
Aiken, SC 29803
Phone (803) 502-1484

1847 S Lake Dr
Lexington, SC 29073
Phone (803) 356-8998

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

972 N 600 E
Spanish Fork, UT 84660
Phone (385) 265-6060

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758758400000",
    "number": "1629882543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749306",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1847 S LAKE DR",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290737759",
            "telephone_number": "803-356-8998",
            "fax_number": "803-356-8999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "972 N 600 E",
            "address_purpose": "LOCATION",
            "city": "Spanish Fork",
            "state": "UT",
            "postal_code": "846601306",
            "country_code": "US",
            "telephone_number": "801-465-4896",
            "fax_number": "801-465-3267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAPPAS",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-03",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "30724",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "12753805-4405",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, SC

Sources for this page

Verify at the official NPI Registry.